Infectious Diseases in Critical Care Medicine

by whether or not there is widening of the mediastinum (with or without other radiographic
findings). Thosewith that finding and a hematocrit of >45% are diagnosed as having
inhalational anthrax as opposed to CAP. Patients on the other arm of the algorithm (patients
without mediastinal widening, but with altered mental status) are diagnosed with inhalational
anthrax. The limitations to this diagnostic scheme are that it was not derived prospectively,
and its application is limited to previously healthy individuals (43).
Kyiacou et al. have developed another algorithm for differentiating CAP from influenza-
like illness utilizing temperature (>100.4 8 F), heart rate (>110 beats/min) and room air pulse
oximetry (<96% saturation). No single characteristic was sufficiently sensitive or specific, but
the algorithm produced a result that was 70.8% sensitive and 79.1% specific for the diagnosis of
CAP (44).

Table 5 Recommended Transmission-Based Isolation Precautions (Continued)

Pathogen

Recommended

isolation precautions Comments

Tick-borne hemorrhagic
fever viruses (Crimean-
Congo hemorrhagic fever
(Nairovirus-a
Bunyaviridae), Omsk
hemorrhagic fever,
Kyasanur forest disease,
and Alkhurma viruses

Standard, contact

Multidrug-resistant
M. tuberculosis

Standard, contact,

droplet, airborne

Extrapulmonary

tuberculosis with

draining lesion

Standard, contact,

airborne

Examine for pulmonary tuberculosis.

Extrapulmonary

tuberculosis,

meningitis, no

draining lesion

Standard, contact,

airborne

Examine for pulmonary tuberculosis.

Extrapulmonary

tuberculosis, laryngeal

disease suspected or

confirmed

Standard, contact,

droplet, airborne

Laryngeal disease is highly contagious and always

accompanied by pulmonary disease.

Minimize aerosol-generating procedures.
SARS virus (SARS-
associated coronavirus)

Standard, contact,

droplet, airborne

Airborne precautions preferred; N95 respiratory
protection, eye protection, “vigilant environmental
disinfection (see http://www.cdc.gov/ncidod/sars)..) (See
Ref. 96 for complete recommendations.) Minimize
aerosol-generating procedures.
West Nile virus
(a Flaviviridae)

Standard, contact

Pandemic and avian
influenza (H5N1
influenza)

Standard, contact,

droplet, airborne

Minimize aerosol-generating procedures.

Monkeypox virus
(Orthopoxvirusof the
Poxviridae family)

Standard, contact,

airborne: airborne

precautions must be

taken until smallpox

excluded

See http://www.cdc.gov/ncidod/monkeypox/ for most

current recommendations. Person-to-person

transmission well documented. Minimize aerosol-

generating procedures.

Hantavirus pulmonary
syndrome

Standard Not transmitted person-to-person.

Genetically engineered
biological weapons

Standard, contact,

droplet, airborne

Unknown potential.

Abbreviation:SARS, severe acute respiratory syndrome.
Source: From Refs. 13, 16–22.

(text continues on page 466)

442 Cleri et al.